QUERY - Acute Kidney Injury

Sample Query form for Acute kidney injury / Query example form for Acute kidney injury / When to query Acute Kidney Injury / Query format for Acute kidney injury

 

Acute Kidney Injury Query Form

Documentation in the medical record indicates that this patient has been admitted with or diagnosed as having .

 

The following lab is also documented in the medical record: [include criteria that apply]

· Creatinine on admission =

· Baseline Creatinine (if known):

· Correction of serum creatinine from ____ to _____ following rehydration

· Urine output :

 

Based on your medical judgment, can you please clarify in the progress notes the diagnosis associated with these findings such as:

· Acute Kidney Injury

· Acute on Chronic Renal Failure

· Chronic Kidney Disease (Stage, if known)

· Other (please specify)

· None of the above / Not applicable

 

In responding to this request, please exercise your independent professional judgment. The fact that a question is asked does not imply that any particular diagnosis is desired or expected.

 

Thank you!